Document resource
Background Bullous keratopathy (BK) is caused by oedema secondary to endothelial cell loss/dysfunction, largely due previous anterior segment surgery or anterior chamber implants. Symptoms of reduced acuity and/or pain can be managed with lubricants, sodium chloride, bandage contact lenses, endothelial keratoplasty/prosthesis or conjunctival flap. Phototherapeutic keratectomy (PTK) has been shown to relieve pain in those with poor visual prognosis.Methods A retrospective review of eyes undergoing PTK for painful BK August 2024-August 2025 at Royal Victorian Eye and Ear Hospital, Melbourne. Central stromal thickness (CST) was ablated <550 µm using the Schwind Amaris 1050rs.Results Eleven eyes of 11 patients were included with acuity 6/150-PL and CST 559-1048um. BK was due to glaucoma filtration surgery (4/11 36%), anterior chamber implants (3/11 27%), Fuch’s endothelial dystrophy (2/11 18%), congenital hereditary endothelial dystrophy (1/11 9%) and penetrating eye injury (1/11 9%). Eleven (100%) had improvement in pain and 8 (73%) were pain-free at median 10 months. Nine (82%) had unchanged acuity and 2 (18%) lost 1 snellen line. No microbial keratitis occurred. Three (27%) had persistent epithelial defects (>14 days) (resolved with medical treatment). No patients underwent further procedures or used bandage contact lenses after re-epithelialisation.Conclusion PTK is a safe and efficacious treatment for painful BK in eyes with poor visual potential. It is comparable to bandage contact lens use (70% pain-free, 13% keratitis risk); cosmetically more acceptable than conjunctival flaps and cheaper than endothelial keratoplasty/prosthesis (£1800+/implant) with a consumable cost of £80 in our unit.